When your doctor suspects that you may have too little or too much iron in your body

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

You may be instructed to fast for 12 hours before sample collection; in this case, only water is permitted.

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The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

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Iron is an essential trace element and nutrient that is necessary to maintain life. The serum iron test measures the amount of iron in the liquid portion of blood.

Iron is absorbed from food and transported throughout the body by transferrin, a protein produced by the liver. Iron is necessary for the production of healthy red blood cells (RBCs). It is an important part of hemoglobin, the protein in RBCs that enables them to carry oxygen throughout the body. Iron is also used in the production of some proteins, including myoglobin and some enzymes.

Normally, about 70% of the iron absorbed is incorporated into the production of hemoglobin inside RBCs. The remainder is stored in the tissues as ferritin or hemosiderin. If not enough iron is taken in from the diet, blood levels will drop; thus, over time, the iron stored in the tissues will be used, eventually depleting the stored iron. Insufficient levels of circulating iron and iron storage will eventually lead to iron deficiency anemia. On the other hand, absorption of too much iron can lead to progressive accumulation and damage to organs such as the liver, heart, and pancreas.

The serum iron test measures the amount of iron that is in transit in the body – the iron that is bound to transferrin. The amount of iron present in the blood will vary throughout the day and from day to day. For this reason, serum iron is almost always measured with other iron tests, such as serum ferritin and the total iron-binding capacity (TIBC), from which the transferrin saturation can be calculated. Transferrin saturation reflects the amount of iron being transported in the blood and its capacity to carry more. The use of several iron tests provides a more reliable measure of iron deficiency and iron overload than measuring serum iron by itself.

How is the sample collected for testing?

A blood sample is drawn by needle from a vein in the arm.

Is any test preparation needed to ensure the quality of the sample?

Morning samples are preferred. Fasting for 12 hours before sample collection may be required. In this case, only water is permitted.

Serum iron, total iron-binding capacity (TIBC), and/or transferrin tests are usually ordered together and, subsequantly, the transferrin saturation can be determined and used to assess how much iron is being carried in the blood. A ferritin test may also be used to evaluate a person's current iron stores.

These tests are used together to detect and help diagnose iron deficiency or iron overload. In people with anemia, these tests can help determine whether the condition is due to iron deficiency or another cause, such as chronic blood loss or some other illness. Iron tests are also ordered if a doctor suspects that a person has iron poisoning and to screen for hereditary hemochromatosis, an inherited condition associated with excessive iron storage.

Serum iron tests are typically ordered as follow-up tests when abnormal results are found on routine tests such as a CBC, with decreased hemoglobin and hematocrit levels. They may also be ordered when iron deficiency or iron overload is suspected.

Early iron deficiency often goes unnoticed. If a person is otherwise healthy, symptoms seldom emerge before the hemoglobin in the blood drops below a certain level (about 10 g per deciliter). As iron storage depletion progresses and anemia begins to develop, some of the following signs and symptoms may appear:

If the iron-deficiency anemia is severe, shortness of breath, dizziness, chest pain, headaches, and leg pains may occur. Children may develop learning (cognitive) disabilities if the deficiency persists. Besides the general symptoms of anemia, there are certain symptoms that are characteristic of iron deficiency. These include pica (cravings for specific substances, such as licorice, chalk, dirt, or clay), a burning sensation in the tongue or a smooth tongue, sores at the corners of the mouth, and spoon-shaped fingernails and toenails.

A serum iron and other iron tests may be ordered when iron overload (hemochromatosis) is suspected. Symptoms of high iron levels will vary from person to person and tend to worsen over time. They are associated with iron accumulation and can be similar to those seen with other conditions. Symptoms may include:

When a child is suspected to have ingested iron tablets, a serum iron test is ordered to detect and help assess the severity of the poisoning. Iron tests may also be ordered periodically when iron deficiency or overload is being treated to evaluate the effectiveness of treatment.

A low iron with a high transferrin or TIBC is usually due to iron deficiency. In chronic diseases, both iron and transferrin or TIBC are typically low. Iron deficiency is usually due to long-term or heavy bleeding. However, it can also be due to increased iron requirements (in pregnancy), rapid growth (in children), poor diet, and problems with absorption (stomach or intestinal disease). Infants between the ages of 6 months and 24 months who are not being breast-fed are particularly susceptible to iron deficiency if supplemental dietary iron is not provided.

High levels of serum iron can occur as the result of multiple blood transfusions, iron injections into muscle, lead poisoning, liver disease, or kidney disease. It can also be due to the genetic disease, hemochromatosis.

Recent consumption of iron-rich foods or iron pills can affect test results, as can recent blood transfusions. Alcohol and drugs, such as oral contraceptives and methotrexate, can increase iron test levels, while testosterone, large doses of aspirin, metformin, and ACTH (adrenocorticotropic hormone) can decrease them.

Iron deficiency refers to a decrease in the amount of iron stored in the body, while iron deficiency anemia refers to a drop in the number of red blood cells (RBCs) and/or the amount of hemoglobin within the RBCs, the end-stage of iron deficiency. It typically takes several weeks after iron stores are depleted for the hemoglobin level to decrease, resulting in reduced production of RBCs. There are few symptoms seen in the early stages of iron deficiency, but as the condition worsens and blood levels of hemoglobin and RBCs decrease, ongoing weakness, pallor, and fatigue can develop.

The form of iron that is easiest for the body to absorb is found in meats and eggs. Other iron-rich sources include: green leafy vegetables (such as spinach, collard greens, and kale), wheat germ, whole grain breads and cereals, raisins, and molasses.

The people who typically need iron supplements are pregnant women and those with documented iron deficiency. People should not take iron supplements before talking to their doctor as excess iron can cause chronic iron overload. An overdose of iron pills can be toxic, especially to children.

Iron deficiency anemia comes on gradually. When your rate of iron loss exceeds the amount of iron you absorb from the gut, iron stores are slowly used up. At this stage, ferritin will be low, but serum iron and TIBC are usually normal and there is no anemia. As the iron deficiency worsens, serum iron levels fall, TIBC and transferrin rise, and anemia starts to develop. With prolonged or severe iron deficiency, the red cells become small and pale due to decreased hemoglobin levels. Reticulocyte production decreases, except following iron therapy.

Yes. Every time you donate a pint of blood, your body loses about 250 mg of iron. The level of serum ferritin, which is a reflection of the total amount of storage iron, drops with each donation and then returns to normal over time. Other tests, such as serum iron and TIBC, are not as affected by blood donation.

Your doctor may suspect that you are not absorbing the iron you need from your supplements and your diet, so she may ask that you have your iron level checked shortly after you take your iron supplement. If you take iron and then have an abnormally low test result, you may have an underlying condition affecting the absorption of iron. You may need to be treated for the condition causing the malabsorption for your iron levels to return to normal.

(November 1, 2007) Centers for Disease Control and Prevention. Hemochromatosis, Biochemical testing. Available online at http://www.cdc.gov/ncbddd/hemochromatosis/training/diagnostic_testing/biochemical_testing.htm through http://www.cdc.gov. Accessed October 2009.

Iron Disorders Institute. Iron Tests. PDF available for download at http://www.irondisorders.org/Forms/irontests.pdf through http://www.irondisorders.org. Accessed October 2009.

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